KNOT PUSHER DEVICE
A knot pusher device for deploying a plurality of pretied knots to a surgical site is provided. In one embodiment, the knot pusher device comprises a shaft, an inner tubular member, and an inner rod, each having a proximal end and a distal end. The inner tubular member is provided within the shaft and is radially translatable with respect to the shaft. The inner rod is provided within the inner tubular member and is slidably coupled to the inner tubular member and is axially translatable with respect thereto.
This invention relates generally to surgical devices, and more specifically to methods and apparatus for advancing surgical knots.
BACKGROUND OF THE INVENTIONVarious medical procedures, particularly cardiology procedures, involve accessing a corporeal vessel through the formation of a hole or opening in the vessel wall so that a medical procedure can be performed. After the particular medical procedure has been performed, the access hole in the vessel wall must be closed.
A number of prior vascular closure devices and methods have been developed in an attempt to provide a solution for the problem of closing a hole in the vessel wall. Tissue approximation typically involves passing a length of suture into and through adjacent vessel and subcutaneous tissue, across the vessel opening, and back into and through adjacent vessel and subcutaneous tissue. A knot may be tied in the suture to maintain the suture in position closing the hole in the vessel wall. Certain prior closure devices have involved relatively complicated methods and devices for extracting a length of suture from inside the vessel so that the physician can approximate tissue surrounding the hole in the vessel wall through use of the suture.
Typically, a hole in a vessel wall is closed using a sliding knot. The knot can be slid along the suture. Thus, the surgical site is contacted with a sliding suture when the knot is pushed or cinched down and thus causes movement of the suture at the tissue site. Tying of the suture with an over hand suture loop enables sliding of the knot while the suture at the tissue site remains stationary. A device for transporting two or more over hand suture loops to percutaneous surgical site would thus be useful.
BRIEF SUMMARY OF THE INVENTIONMethods and apparatus for advancing surgical knots are provided. More specifically, a knot pusher device for deploying a plurality of pretied knots to a surgical site is provided.
In one embodiment, the knot pusher device comprises a shaft, an inner tubular member, and an inner rod, each having a proximal end and a distal end. The inner tubular member is provided within the shaft and is radially translatable with respect to the shaft. The inner rod is provided within the inner tubular member and is slidably coupled to the inner tubular member and is axially translatable with respect thereto.
In another embodiment, the knot pusher device comprises a suture portion and a handle portion. The suture portion comprises a shaft, an inner tubular member, and an inner rod, each having a proximal end and a distal end. The inner tubular member is provided within the shaft and is radially translatable with respect to the shaft from a first closed position to a second open position. In the first closed position, axial translation of a second suture knot. The inner rod is provided within the inner tubular member and axially translatable with respect thereto. The handle portion includes an actuator assembly and is disposed at the proximal end of the outer shaft. The actuator assembly includes a first actuator coupled to the inner tubular portion and a second actuator coupled to the inner rod.
Methods and apparatus for advancing surgical knots are provided. More particularly, a knot pusher device for advancing suture knots at a wound or surgical site is provided. The knot pusher device in accordance with the present invention may be used to transport a plurality of overhand suture loops to a surgical site. It should be appreciated by those skilled in the art, however, that the knot pusher device may be used in conjunction with various types of knots in a variety situations to seal any suitable wound or surgical site.
Generally, to advance overhand suture loops to a surgical site with percutaneous delivery, it is desirable to separate each suture loop during advancement. By providing two loops, the first loop may approximate the wound lips and seal the hole in the vessel and the second loop may secure the sealing result, tightening the knot, and maintaining tightness of the seal during pulsation.
The knot pusher device comprises an suture portion 5, shown in
The outer shaft 10 includes one or more axial passages 40 extending over at least a portion of the length of the outer shaft. As shown, the axial passages 40 begin at the distal end 15 and terminate distally of the proximal end 20. As shown in
An inner tubular member 80 is provided within outer shaft 10. The inner tubular member 80 extends substantially from the distal end 15 of the outer shaft 10 to the proximal end 20 of the outer shaft 10. The inner tubular member 80 is generally concentric with the outer shaft 10. In the embodiment shown, the inner tubular member 80 has a semicircular profile along its entire length. In alternative embodiments, the inner tubular member 80 may have varying profiles. The inner tubular member 80 is radially translatable with respect to the outer shaft 10. As can be best seen in
An inner rod 35 may be provided with the inner tubular member 80. The inner rod 35 is axially translatable within the inner tubular member 80. The inner rod 35 may be formed of any suitable material. Softer materials, such as a polymeric material, generally allow for ease of transport along the suture filaments 52 because a lower dynamic friction is caused by the softer inner rod 35 traveling along the suture filament 52. The distal end of inner rod 35 is shown in its fully retracted position in
With particular reference to
Referring to
The inner tubular member 80 can be rotated or radially translated by displacing the first actuator knob 60 radially through a first actuator slot 75. In one embodiment, the inner tubular member 80 can be rotated up to approximately 90 degrees. Prior to rotation, or with the first actuator knob 60 in the position shown in
The spring 70 is maintained under compression between the first actuator knob 60 and the second actuator knob 65 such that the second actuator knob 65 remains proximally retracted relative to the inner rod 35. The inner rod 35 may be driven distally, or axially translated, by displacing the second actuator knob 65 axially through a second actuator slot 80. It will be appreciated that a wide variety of other actuator mechanisms could alternatively be used.
Referring again to
When the suture portion 5 contacts the surgical site, the first suture loop 50 may be deployed at the surgical site. In embodiments where the first suture loop 50 is a pre-tied knot, the first suture loop 50 is substantially deployed upon contacting the surgical site. To provide a tight and secure knot over the site, forward pressure may be applied to the handle 100 while a tensioning action is applied to the tensioning knob 312. Generally, more pressure applied to the handle 100 and tensioning knob 312 creates more security in the knot. The first suture loop 50 approximates the wound lips and seals the surgical site. Thus, when used to seal an arteriotomy, the first suture loop 50 affects closure of the arteriotomy.
Upon contact of the suture portion 5 with the surgical site, the second overhand suture loop 55 may also be deployed at the surgical site. In one embodiment, deployment of the second overhand suture loop 55 is accomplished by first displacing the first actuator knob 60 radially through the first actuator slot 75. Such actuation causes the inner tubular member 80 to rotate from the closed position to the open position. In the open position, the inner tubular member 80 is aligned with the axial passage 40 such that the second overhand suture loop 55 is free to advance in the distal direction.
The second overhand suture loop 55 is driven in the distal direction by actuation of the second actuator knob 65 axially through the second actuator slot 80. Such actuation causes the inner rod 35 to be driven distally, which, in turn, drives the second overhand suture loop 55 distally through axial passages 40 and out of the suture portion 5 through the lumen 85. The second suture loop 55 secures the sealing result of the first suture loop 50, tightens the knot, and minimizes any loosening of the knot under pulsation.
As previously discussed, during deployment of the knots 50, 55 to the surgical site, it may be desirable to keep the suture filaments 50, 55 in tension. More specifically, it may be desirable to keep the suture filaments at the end of the handle 100 in tension. This can be done by pulling the suture filaments proximally, manually or by using a tensioning knob, while advancing the handle 100 to deliver the knots 50, 55.
In some embodiments, the knot pusher device may be used in conjunction with a vascular closure delivery device such as shown in
Although the invention has been described with reference to preferred embodiments, persons skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention.
Claims
1. A knot pusher device for deploying at least one suture knot, the knot pusher device comprising:
- a shaft having a proximal end and a distal end;
- an inner tubular member provided within the shaft, the inner tubular member having a proximal end and a distal end, wherein the inner tubular member is radially translatable with respect to the shaft; and
- an inner rod provided within the inner tubular member, the inner rod having a proximal end and a distal end, wherein the inner rod is slidably coupled to the inner tubular member and is axially translatable within the inner tubular member.
2. The knot pusher device of claim 1, wherein the inner rod is generally concentric with the shaft.
3. The knot pusher device of claim 1, wherein the inner tubular member comprises a soft polymeric material.
4. The device of claim 1, further comprising an actuator assembly disposed at the proximal end of the shaft to facilitate axial translation of the inner rod and radial translation of the inner tubular member.
5. The device of claim 4, wherein the actuator assembly comprises a first actuator to facilitate axial translation of the inner rod and a second actuator to facilitate rotational translation of the inner tubular member.
6. The device of claim 1, wherein the device is used to deploy pretied overhand suture loops.
7. The device of claim 1, wherein the shaft includes a plurality of axial passages to facilitate axial movement of a suture knot.
8. The device of claim 1, wherein the device may be used for pushing and deploying a plurality of suture knots to a surgical site.
9. A knot pusher device for deploying first and second suture knots, the knot pusher device comprising:
- a suture portion comprising: a shaft having a proximal end and a distal end; an inner tubular member provided within the shaft, the inner tubular member having a proximal end and a distal end, wherein the inner tubular member is radially translatable with respect to the shaft from a first closed position to a second open position, wherein, in the first closed position, axial translation of the second suture knot is substantially prevented; and an inner rod provided within the inner tubular member, the inner rod having a proximal end and a distal end, wherein the inner rod axially translatable with respect to the inner tubular member; and
- a handle portion including an actuator assembly, the handle portion being disposed at the proximal end of the shaft, the actuator assembly including a first actuator coupled to the inner tubular portion and a second actuator is coupled to the inner rod.
10. The knot pusher device of claim 9, wherein the handle further comprises a tensioning knob.
11. The knot pusher device of claim 10, wherein a suture filament extends from the distal end of the inner rod, through the inner rod, out the proximal end of the inner rod, into the handle, translation of the inner tubular member and the second actuator effects axial translation of the inner rod.
13. The knot pusher of claim 9, wherein the handle further comprises a compression spring, the second actuator being coupled to the compression spring and the inner tubular extending through the compression spring.
14. The knot pusher device of claim 9, wherein the second position of the inner tubular member is approximately 90 degrees offset from the first position of the inner tubular member.
15. The knot pusher device of claim 9, further including first and second pretied suture knots, the first and second pretied suture knots being provided within the suture portion of the knot pusher device.
Type: Application
Filed: Oct 20, 2006
Publication Date: Apr 24, 2008
Patent Grant number: 8906044
Inventors: Jyue Boon Lim (New Brighton, MN), Raimar Boehlke (Chanhassen, MN)
Application Number: 11/551,635
International Classification: A61B 17/04 (20060101);